Despite the lure of six-figure salaries, hospitals are struggling to recruit nurses trained to administer anesthesia.

Things are so bad that some hospitals are cutting back on elective surgeries and boosting salaries, with the average nurse anesthetist earning $104,000 a year-and some are getting offers of as much as $180,000. That's more than the average family practice physician earns, says Allied Consulting, a Texas medical recruiting firm.

The shortage is part of an overall workforce problem facing hospitals, which can't find enough pharmacists, radiology technicians, registered nurses or anesthesiologists. The shortage of nurses and nurse anesthetists is expected to worsen, with the average age of nurses creeping upward and non-hospital jobs proliferating.

"I begged, pleaded and whined," says Kevin Smith, explaining how he filled three nurse anesthetist positions at his 99-bed hospital in Thief River Falls, Minn. It took him 10 months, even offering about a 20% salary premium over the going rate in the Minneapolis/St. Paul area, where nurse anesthetists earn $110,000 to $130,000 annually.

And the problem isn't limited to rural hospitals, although the consequences of the shortage for small hospitals can be dire.

"Nurse anesthetists are particularly critical in rural hospitals," says Carmella Coyle of the American Hospital Association. "Without them, they might not otherwise be able to provide anesthesia services."

Nurse anesthetists provide more than 68% of all anesthesia services in the country and are the sole providers of anesthesia in nearly half of all hospitals, according to their professional association. And that percentage could climb.

Salary offers

Other than physicians, nurse anesthetists are among the highest-paid health care providers.

Nurses, even at the high end of the salary range at $180,000 a year, make less than physicians trained in anesthesia, who average $240,000 annually, according to a survey by Allied.

The nurses work alongside surgeons, anesthesiologists and dentists in hospitals, surgery centers and doctors' offices, providing anesthesia for surgery and pain-management care. About 44% of nurse anesthetists are men, compared with 5% in nursing overall.

Nurse anesthetists must have at least one year of critical-care nursing experience before applying to nurse-anesthetist graduate school, which takes 24 to 36 months to complete. They also must pass a national certification exam.

Medicare requires that physicians oversee nurse anesthetists, but last year adopted a rule allowing states to opt out of that requirement. Four-Iowa, Nebraska, Idaho and Minnesota-have done so.

Many physicians oppose lifting such restrictions, fearing it could affect patient care, encroach on their job responsibilities or affect their incomes.

"We think it's a reduction in the level of care for patients," says Dr. Barry Glazer, president of the American Society of Anesthesiologists. He says studies have shown that outcomes are worse, even when the nurse is working under the supervision of a surgeon, rather than an anesthesiologist.

While the anesthesiologists association has fought the independent practice of nurses, the nurse anesthetists point to studies showing that the quality of anesthesia care has greatly improved in the past 20 years.

"I would put myself up against any anesthesiologist in the country," says nurse anesthetist Roman Dashawetz, who has practiced for 25 years. "I've done everything from liver transplants to open-heart surgeries. Maybe my total medical knowledge is less than an anesthesiologist's, but my specific knowledge of medical programs that affect anesthesia is as great."

The biggest hurdle for most hospitals now seems to be finding enough nurse anesthetists to go around.

Dashawetz, chief of anesthesia at the tiny 18-bed hospital in Machias, Maine, is looking to add one more nurse anesthetist, rounding out his staff to three. He's shopping around. The salary? In the range of $110,000. That will buy a lot of house in Machias, population 2,300, but he still has no takers.

Hospitals in urban centers are scrambling, too, although salaries tend to be a bit lower in the big city.

Cincinnati Children's Hospital Medical Center has doubled its staff of nurse anesthetists, to six from three, but is still short, mainly because of a shortage of anesthesiologists. The hospital has closed two of its 16 operating rooms.

"Everyone who has a surgery that must take place, it takes place, but there are times when the wait is a little longer than we would like," spokesman Jim Feuer says.

It's not that there isn't interest in joining the field. The 85 nurse anesthetist graduate programs around the country report having to turn away students because they are full.

"On average, there's about 23 qualified applicants for every open position," says Betty Horton with the American Association of Nurse Anesthetists.

The number of graduates has fluctuated in the past five years, ranging from a low of 881 in 1999 to 1,129 last year.

"It's a very good career and not just from a salary standpoint," says Chris Bettin, spokesman for the nurses' professional association. "There's a certain level of autonomy that is unique to the nursing profession."

Olga Williams has been a nurse anesthetist since 1971-and has seen the profession change, particularly the salaries. Once, such nurse anesthetists were paid the same as a floor nurse supervisor.

Now, they earn considerably more. Hospitals also vary on how much autonomy the nurses have.

"At some, you never see an anesthesiologist," says Williams, who works at Loudoun Hospital Center in Leesburg, Va. "At others, they're hovering over you. Right now, I feel I have sufficient autonomy, but someone is there if I need them."

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Your welcome, I liked the demographics of the article. Also, as a recruiter -(yep, one of those people) it helps to keep abreast of the supply/ demand issues. Since I saw so many nurses that were considering becoming a CRNA on this board I thought it may help them make a decision. The supply for NP's are much greater than CRNA's.

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What I meant Brett was that there are more NP's in supply then CRNA's. Therefore the applicants, for example, for one full time position would normally be greater (more competition) than a job for a CRNA. Hope that clarifies!

Barbara

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It is great to know that the demand for CRNAs is way up, but I worry that sooner than we all think that the supply will be up there too. Take for example the boat loads of people we all know that are planning on becoming crna. However, I suppose the fact that the number of seats in each program are extremely limited. Anyone feel this way?

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I don't think that the number of seats or number of CRNA schools will increase drastically in the near future. As for the boat loads of people woth are planning of becoming CRNAs, the compitition will get stiffer. Just my opinion.

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